Check your doctors
Most Medicare Advantage plans, including HMOs and PPOs, use provider networks, and networks can change between plan years and during the year. Here’s how to check your doctors before you choose coverage.
WHERE YOU GET CARE MATTERS
Across Southern California, many people rely on care from health systems such as City of Hope in Duarte, Huntington Health in Pasadena, Kaiser Permanente, Cedars-Sinai, UCLA Health, and Keck Medicine of USC, including USC Arcadia Hospital.
Whether a particular doctor or hospital is covered depends on the specific plan, the specific doctor, and the plan year. A doctor who is in one plan’s network may not be in another’s, even when the plans come from the same company.
Shawnee Financial & Insurance Services is not affiliated with or endorsed by the health systems named on this page. Their names are used only to help you identify where you receive care.
THE BASICS
You can see any doctor or hospital in the U.S. that accepts Medicare. A Medigap policy, if you have one, works alongside it. Medicare SELECT policies are the exception: they can require network hospitals, and sometimes network doctors, for full benefits.
You generally use the plan’s network, except for emergency care, out-of-area urgent care, and temporary out-of-area dialysis. You usually choose a primary care doctor, and specialists often require a referral.
You can see providers outside the network, usually at a higher cost. Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Call the plan’s customer service number or see its Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
A CALIFORNIA DETAIL
In California, many Medicare Advantage HMO plans work through contracted medical groups or independent practice associations (IPAs).
Your primary care doctor usually belongs to a medical group, and that group arranges your referrals and specialist care. For an HMO plan, the doctor’s medical group generally needs a contract with that plan. When you enroll, you may choose a primary care doctor and medical group, or one may be assigned.
That is why “Does this hospital take my plan?” is only part of the question. It also helps to ask which medical group your doctor is with, and whether that group works with the plan you are considering for 2027.
FIVE STEPS
Write down every doctor and specialist you see, their medical group, the hospital you would want to use, and where you go for lab work or imaging. Include your pharmacy and prescriptions.
Call your doctor’s office or the medical group’s insurance line. Ask: “Which Medicare plans will Dr. ___ and this medical group be contracted with for 2027?” Ask about the doctor by name, not just the clinic or hospital.
Search the plan’s own provider directory. Make sure it shows the 2027 plan year and the exact plan name, and check the medical group listed for your doctor.
Medicare.gov’s Plan Finder lists plans available in your ZIP code and estimates prescription costs. Use it alongside each plan’s directory.
Directories are not always current. Note who you spoke with and when. If a doctor is essential to you, confirm with both the office and the plan.
Networks can change between plan years and during the year, so check even if you plan to keep your current coverage. Read the 2027 enrollment guide.
Networks are specific to each plan, doctor, and medical group, and they can change from year to year and during the year. Medicare also has rules about how agents can advertise plan details. The most reliable answer comes from checking your own doctors against specific plans, which Stephanie can do with you one-on-one.
Accepting Original Medicare does not mean a doctor is in every Medicare Advantage plan’s network. Ask specifically about the plan and medical group you are considering for 2027.
Kaiser Permanente operates hospitals and medical offices and also offers health coverage. If you get care at Kaiser facilities, ask Kaiser Permanente how its facilities work with the coverage you are considering, and confirm before you enroll.
Yes. Networks and medical group contracts can change during the year. Plans are generally required to notify affected members. If it happens, Stephanie can talk through your options with you.
No. Shawnee represents 10 organizations offering 64 products in your area. For information on all of your options, contact Medicare.gov or 1-800-MEDICARE.
LET’S FIND YOUR WAY FORWARD
Stephanie will check your doctors and prescriptions against the 2027 plans she represents, and explain what she finds in plain language.
